Danica Mitchell

Accessibility vs. Affordability: Balancing Quality of Care with Cost

By April 26th, 2024 No Comments

The decision to go to therapy, be it for the first time or as a returning veteran, is a big one. It is a wonderful investment in your overall wellness and mental health, however, at least in the US, therapy is also a financial decision. It can be incredibly frustrating to make the decision to go to therapy only to find it extremely difficult to find a therapist in-network with your insurance, or who has an out-of-network fee you can afford.
In this blog, we dive into some of the various factors that dictate the cost of therapy. At the end of the day these factors contribute to the balancing act of providing quality care and making therapy accessible to diverse populations.

Challenges in Balancing Quality and Cost

Quality of care is an important factor when it comes to mental health care of any kind. In order to provide care to clients treatments must be individualized, culturally competent, evidence based, and up-to-date with leading research and new and promising modalities.

  • Education & Training – All therapists regardless of licensure must have appropriate education and training. Typically therapists hold advanced degrees such as Masters or Doctorate degrees and have spent years of supervised training which contribute to fee rates.
  • Licensure – Therapists hold various licenses which are dictated by the state. Most therapists have to maintain those licenses per state. So if a therapist can practice in 3 states, which improves access to care, especially in areas where it is common to live and work across state lines, they are personally taking on the cost to do so.
  • Continuing Education – Mental health professionals must continue their education in order to maintain their licensure. Which while costly is good news as it means your therapist is expected to always be learning and gaining new skills that can benefit you.
  • Specialization & Experience – This often leads to therapists specializing in topics or modalities that resonate with them. This means they may be better equipped to support certain diagnoses or execute less common modalities. But these all come with additional education and training and therefore higher fees. Additionally, those with many years of experience often have higher fees due to that experience.

Additional factors such as experience, geographic location, length, type and frequency of sessions can all be factors that can impact fees.

Financial Sustainability for Therapists

Many individuals who choose to go into helping fields such as mental health often do so out of a desire to help others. However, in our current system, that comes with balancing the cost of business.

Therapists’ fees often factor in the overhead costs of the practice. This may include office space, utilities, insurance, administrative staff, electronic health records, marketing and more. This cost may be lower at a group practice where the fees of multiple therapists can share the burden of business costs. So while therapists’ fees may seem high, your therapist is not taking that entire fee home with them as it is divided amongst the many costs to run a practice.

Insurance & Reimbursement

A frustrating experience of many people seeking therapy is in discovering that fewer and fewer therapists are accepting insurance. This is due to a few reasons.

  • Insurance Boards – Therapists must apply to be accepted on insurance boards individually. While this should be a straightforward process often that isn’t the case as boards may deny therapists because they have specific quotas for demographics and skills based on location. But even if a therapist is accepted to a specific insurance board the difficulty doesn’t end there.
  • Reimbursement Rates – Different insurances reimburse differently. For example if a typical therapy session was $200, and the client’s co-pay was $50, you might expect that the insurance would cover the difference of $150. However, that typically is not the case with most insurances having incredibly low reimbursement rates that aren’t even half the remaining cost. Additionally, in other professions where it can be expected to have minimal raises to keep up with cost of living increases, insurance reimbursements stay the same if not lower over time.
  • The Admin of Insurance – Most often therapists are only paid for the time they spend in sessions. Insurance requires claims to be submitted after each session, and it is very common for insurances to deny claims which requires therapists to follow up with insurances which often takes hours of calls – all of which goes unpaid. Many therapy practices hire admin to submit and process claims but that is another overhead cost. And even when claims are finally accepted it may mean a delay in payment for a session for months.

While there are many valid reasons therapists often won’t accept insurances primarily and systemic barriers in general, that does not lessen the necessity of quality mental health care access.

Solutions and Strategies

In order to combat limited accessibility therapists have a few strategies. Therapists will often reserve a few slots on their caseload to accommodate clients.

  • Sliding Scale Fees – Therapists may offer sliding scale fees, which are fees based on clients’ income. This allows therapists to offer more reasonable rates for those in need. These are often limited to a small number of clients so that the practice can still run overall.
  • Reduced-Fee Services – Therapists may reduce fees temporarily. Especially in the recent economy there may be temporary circumstances that put financial strain on people such as a job loss, a medical bill, or a rent increase. Therapists may be able to temporarily lower fees for a period of time due to financial hardships.
  • Session Frequency – While weekly therapy tends to be the gold standard, depending on the presenting problem, how long someone has been in therapy before, and various support systems many therapists are able to reduce session frequency therefore opening up room for new clients while also maintaining therapeutic support. This may be temporary or long term depending on how clinically appropriate it is.
  • Advocating for Policy Changes – Many mental health providers are at the forefront of advocating for policy change and increasing mental health access. This may include things like Universal Health Care, having insurance accept teletherapy to improve access, or advocating for more national regulations around therapy making it easier for therapists to work in multiple states.

In a perfect world therapy would be accessible to anyone that wants it, because not only is therapy a great tool for when you need it, it is also beneficial simply when you desire a space to grow. People should have access to that support and therapists should be able to provide quality care without worrying that they will be able to pay their own bills.

Until then, it is important that people feel they are able to understand the cost behind therapy and what avenues may be available to make therapy more accessible. At the end of the day it is a balancing act of finding the right provider at the right cost, and never be afraid to ask about sliding fees or reduced sessions as many therapists have some ability to provide them.

At Peaceful Way Psychology we aim to be honest and transparent about the cost of therapy. If you think one of our therapists may be right for you, you can schedule a free 15 minute consultation today or reach out via our contact form if you already have someone in mind.